BIOPSY-CONFIRMED HIGH GRADE SQUAMOUS CERVICAL LESIONS (HSIL) IN PATIENTS WITH CYTOLOGICAL DIAGNOSIS OF ATIPICAL SQUAMOUS CELLS (ASC)

BIOPSY-CONFIRMED HIGH GRADE SQUAMOUS CERVICAL LESIONS (HSIL) IN PATIENTS WITH CYTOLOGICAL DIAGNOSIS OF ATIPICAL SQUAMOUS CELLS (ASC)

Raluca  Bălan, D. Neacşu, Vl. Gheorghiţă, Cornelia Amalinei, Irina Draga Căruntu, Florentina Pricop 

UMF “Grigore Popa” Iaşi

Rezumat – Leziunile HSIL confirmate prin biopsie la pacienţi cu diagnostic citologic de celule scamouase atipice

       Denumirea de “celule scuamoase atipice” (ASC) reprezinta modificarile histologice sugestive pentru o leziune intraepiteliala care, din punct de vedere al calitatii si cantitatii, este insuficienta pentru o clasiifcare certa. Sistemul  Bethesda 2001 propune impartirea acestei categorii in “celule scuamoase atipice cu semnificatie necunoscuta” (ASC-US) si “celule scuamoase atipice care nu pot exclude leziunea intraepiteliala de grad inalt” (ASC-H).

Studiul analizeaza legatura dintre diagnosticul histopatologic si aspectul citologic de tip ASC-US si ASC-H. Este un studiu retrospectiv, in care au fost revizuite, conform sistemului Bethesda 2001, toate frotiurile cervico-vaginale categorisite ca si ASCUS pe o perioada de 8 ani (2002-2009). Diagnosticul de certitudine a fost histopatologic, la cazurile la care s-a prelevat biopsie. Dintre 780 de frotiuri analizate, 366 (47%) au fost diagnosticate ca ASC-H si 414 (53%) ca ASC-US.   Dintre pacientele aflate in categoria ASC-H, la 249 (68%) s-a prelevat intr-un al doilea timp biopsie cervicala. 87 (35%) dintre aceste paciente au fost diagnosticate cu HSIL. Dintre pacientele diagnosticate cu ASC-H, numai la 178 (43%) s-a prelevat biopsie. Dintre ele  30 (17%) au fost diagnosticate cu HSIL. Nu au existat cazuri de carcinom cervical. Dintre cele 427 cazuri la care s-a efectuat biopsie,la 77 (18%) s-a semnalat o discrepanta intre diagnosticul histologic si citologic. Frecventa leziunilor cervicale scuamoase de grad inalt a fost mai mare la pacientele cu citologie ASC-H. prezenta a doua categorii diagnostice,  ASC-US and ASC-H, duce la o descriere mai riguroasa a leziunilor scuamoase intrecervicale, cu efecte pozitive asupra prognosticului si tratamentului.

Abstract

       The name of “atypical squamous cells” (ASC) represents cytological changes suggestive for an intraepithelial squamous lesion which, in terms of quality and quantity, is not sufficient for a definitive interpretation. The Bethesda System 2001 has proposed the division of this category in “atypical squamous cells of undetermined significance” (ASC-US) and “atypical squamous cells when high grade intraepithelial lesion cannot be ruled out” (ASC-H). The study analyzes the correlation of the histopathological diagnosis with the cytological pattern of ASC-US and ASC-H. It was performed a retrospective study, being reviewed, according to the Bethesda System 2001, all cervicovaginal smears, diagnosed as ASCUS, for a period of 8 years (2002-2009). The histopathological diagnosis, for the biopsied cases, was considered as standard. From the 780 analyzed smears, 366 (47%) were diagnosed as ASC-H and 414 (53%) were diagnosed as ASC-US. From the ASC-H category of patients, 249 (68%) underwent a later cervical biopsy.  Among these, 87 (35%) were diagnosed with HSIL. From the ASC-US category of patients, only 178 (43%) underwent a later cervical biopsy. Among these, 30 (17%) were diagnosed with HSIL. There were no cases of cervical carcinoma. From the 427 biopsied cases, 77 (18%) presented a discrepancy between histological and cytological diagnosis. The frequency of high grade squamous lesions was higher in patients with ASC-H cytology. The existence of two cytological diagnostic categories, ASC-US and ASC-H, lead to a more rigorous identification of the cervical intraepithelial squamous lesions, with favorable effects upon the treatment and prognostic.

Keywords: cervical intraepitelial squoamos lesion, ASC-US, ASC-H, HSIL